Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2021; 9(26): 7717-7728
Published online Sep 16, 2021. doi: 10.12998/wjcc.v9.i26.7717
Influencing factors for hepatic fat accumulation in patients with type 2 diabetes mellitus
Meng-Jiao Wu, Qiong-Lei Fang, Sheng-Yi Zou, Yan Zhu, Wen Lu, Xuan Du, Bi-Min Shi
Meng-Jiao Wu, Qiong-Lei Fang, Sheng-Yi Zou, Yan Zhu, Wen Lu, Xuan Du, Bi-Min Shi, Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
Author contributions: Wu MJ and Fang QL contributed equally to this study; Du X and Shi BM developed the study concept and design; Wu MJ and Fang QL mainly implemented the study; Wu MJ, Lu W, Zou SY, Zhu Y, and Fang QL registered the study patients and performed physical examination and medical treatments; Wu MJ and Zhu Y were responsible for measuring plasma lipid parameters; Wu MJ and Du X drafted the manuscript and performed statistical analyses; Wu MJ, Fang QL, and Du X interpreted the data and critically revised and completed the manuscript; all authors read and approved the submitted manuscript.
Supported by Suzhou Health Committee and Science and Technology Bureau, No. KJXW2019005.
Institutional review board statement: The study was approved by the Institutional Review Board of the First Affiliated Hospital of Soochow University, and written informed consent was obtained from all participating patients before the initiation of the study.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have nothing to disclose.
Data sharing statement: The datasets analyzed in current study are not publicly available due to relevant ongoing studies, but may be available from the corresponding authors upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xuan Du, MD, Doctor, Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, No.188 Shizi street, Suzhou 215000, Jiangsu Province, China, cathy-dx0630@163.com
Received: March 24, 2021
Peer-review started: March 24, 2021
First decision: May 12, 2021
Revised: May 23, 2021
Accepted: July 23, 2021
Article in press: July 23, 2021
Published online: September 16, 2021
Abstract
BACKGROUND

Non-alcoholic fatty liver disease has become the most common chronic liver disease worldwide, which originates from the accumulation of triglyceride (TG) in the liver. Patients with type 2 diabetes mellitus (T2DM) are considered to have a predisposition to hepatic steatosis. However, the influencing factors for hepatic fat accumulation in T2DM patients remain unclear.

AIM

To investigate the influencing factors for hepatic fat accumulation in T2DM patients.

METHODS

We enrolled 329 T2DM patients admitted to the Endocrinology Department of the First Affiliated Hospital of Soochow University, who underwent MR mDIXON-Quant examination to quantify the hepatic fat fraction (HFF). According to body mass index (BMI), the patients were divided into normal weight, overweight, and obese groups. The differences in general statistics, biochemical parameters, islet function, and HFF were compared among the three groups. The associations between HFF and other parameters and the influences of various parameters on the severity of hepatic fat accumulation were analyzed.

RESULTS

The HFF of T2DM patients gradually increased in the normal weight, overweight, and obese groups (P < 0.05). Spearman correlation analysis showed that in T2DM patients, HFF was negatively correlated with age and high-density lipoprotein cholesterol (P < 0.05), whereas it was positively correlated with BMI, waist-hip ratio, fasting plasma glucose, alanine aminotransferase (ALT), aspartate aminotransferase, bilirubin, glutamyl transpeptidase, lactate dehydrogenase, albumin (ALB), uric acid (UA), total cholesterol, TG, low-density lipoprotein cholesterol (LDL-C), C-reactive protein, free triiodothyronine, fasting insulin, fasting C-peptide, and homeostasis model assessment of insulin resistance (P < 0.05). Multiple linear regression analysis showed significant positive influences of BMI, ALT, LDL-C, UA, and ALB on HFF in T2DM patients (P < 0.05). Binary logistic regression analysis showed that BMI, ALT, ALB, and LDL-C were independent risk factors for moderate to severe fatty liver in T2DM patients, and obesity increased the risk of being complicated with moderate to severe fatty liver by 4.03 times (P < 0.05).

CONCLUSION

The HFF of T2DM patients increases with BMI. Higher BMI, ALT, ALB, and LDL-C are independent risk factors for moderate to severe fatty liver in T2DM patients.

Keywords: Type 2 diabetes mellitus, Non-alcoholic fatty liver disease, Hepatic steatosis, Obesity, MR mDIXON-Quant imaging, Cross-sectional study

Core Tip: Previous studies have showed a bidirectional association between non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM), as the existence of one circumstance aggravates the development of the other. NAFLD originates from the accumulation of triglyceride in hepatocytes, which may consequently lead to further liver injury. This study precisely quantified hepatic fat content by MR mDIXON-Quant imaging, and found that higher body mass index, alanine aminotransferase, albumin, and low-density lipoprotein cholesterol were associated with severer hepatic steatosis in T2DM patients. The MR mDIXON-Quant imaging might play an important role in future research and clinical management of NAFLD.